OPHTE# ?-s)o - N100 Harnett County Department of Public Health 19978
PERMIT # a 3 S71 Operation Permit
✓ " Installation k"ptic Tank D Repair g Nitrification Line 0 Expansion
PROPERTY LOUITION:
Name: owner
SUBDIVISION I r-0 A 1 LOT # I t
System Installer. C Curt. Registration #
Basement with plumbing: El Garage -Humber of Bedrooms _
Type of Water Sup~jIY: ❑ Community ❑ Public ❑ ell Distance from well r-> feet
System Type: (A d c=,,3 r ct`- ~ f U-6 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
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IM system has been mst*d in compliance with able Made Carokm General Sautes, Rules for Treatment W tlnp * Vd all ("eiom of dw o "RM ?"t and LommKtion AU610hadon.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the se a disposal tem on dye above captioned property. r
Type of system: El Conventional Other - c ~c Size of tank: Septic Tank gallons Pump Tank: gallons
Subsurface No. of exact length width of t 3 depth of
Drainage Field ditches , of each ditch feet ditches feet ditches inches
French Drain Required: linear feet
Authorized State Agent 4:J LX
Date U~"~ 1'6